70,000 vets still have chance to gain 'retiree' status

October 31, 2013

by Tom Philpott

About 70,000 disabled veterans who
served on active duty after 9/11, and were medically discharged with
disability ratings of 20 percent or less, still have a shot to gain
“retiree” status, with base shopping privileges and lifetime
eligibility to TRICARE for them and families.

The catch is they have to know about
this opportunity and to apply.

Applying is a breeze. Notifying
eligible veterans they can apply is the greater challenge. Efforts
to reach many of them by mail have been delayed.

To win an upgrade in disability rating,
qualified vets don’t have to appear before one more medical or
physical disability evaluation board. They only have to fill out a
short application form, send it to a panel called the Physical
Disability Board of Review (PDBR), and wait until the PDBR reviews all
relevant health records and decides whether the veteran’s parent
service did indeed low-ball their original disability rating.

For many years, the Army led the
services in tweaking policy and using the VA Schedule for Rating
Disabilities in ways that kept ill and injured soldiers from a combined
rating of 30 percent or higher to quality for disability
retirement. It was less costly to rate a single unfitting
condition, ignore others and separate rather than retire soldiers, by
awarding ratings of 0, 10 or 20 percent.

In 2008, Congress ordered the services
to clean up their disability evaluation systems and end such
practices. It also directed the Department of Defense to establish
the PDBR with authority to reexamine medical files and, if appropriate,
recommend that ratings of vets medically separated from Sept. 11, 2001,
to Dec. 31, 2009, be raised to 30 percent or higher.

PDBR applicants don’t need to
worry about a ratings downgrade. That’s prohibited.
Yet more than three years after the PDBR began operating, only 6800
veterans have applied for review. Of those, the PDBR has decided
3800, recommending disability upgrade and retiree status for 27
percent. That’s down from a rate of 45 percent through
2011.

The services decide whether to accept
PDBR recommendations to upgrade a rating to at least 30 percent and
allow “retiree” status. Such a re-characterization
triggers eligibility for retroactive retired pay back to date of
discharge (minus separation pay previously awarded) and full military
retiree benefits. TRICARE eligibility also in retroactive so a
newly minted retiree able to document out-of-pocket medical costs since
time of discharge can files a claim with TRICARE.

Most of 1033 veterans who have won
“retiree” status through PDBR review are Army
veterans. The top three medical conditions given revised ratings
were post-traumatic stress, back ailments and arthritis.

To date, Air Force and Coast Guard
authorities have approved every PDBR recommendation. Army has accepted
98 percent of them. The Navy Department, for sailors and Marine
applicants, has approved 94 percent.

These “adoption rates” hint
at the thoroughness of review work being done by the PDBR three-member
panels assigned to review individual medical histories of applicants,
said PDBR director James Davis.

“The services are probably not
too crazy about having their homework checked. That’s what
we do,” Davis told the Defense
Department’s Recovering Warrior Task Force on Tuesday, during a
briefing on PDBR progress over for the last year.

But if the PDBR ever got negative
“pushback” from the services it doesn’t any more,
Davis
suggested. He said three weeks ago a doctor on the Navy Board for
the Correction of Military Records told him that when Navy board members
are reviewing difficult cases they look to PDBR decisions “as a
gold standard,” Davis said. “So it’s good
news about what we do.”

What continues to disappoint is the
number of applicants. Only eight percent of eligible veterans have
applied to PDBR to review their disabilities, a rate that suggests many
don’t even know the board exists.

The PDBR was born of controversy and,
ironically, a fresh controversy in late 2011, over how the Army was
rating mental health disabilities, served to sideline plans to notify
more eligible veterans about the PDBR.

In January 2012, the PDBR unveiled a
plan for a phased mailing of information packets and application forms
to every qualified veteran with a current address on file at the
VA. The first batch of 15,000 was to be sent to those medically
separated in 2001 (post-9/11), 2002 or 2003. Three more mailings,
grouped by years of separation, were planned through October 2012 so
information on the PDBR would reach almost every veteran discharged a
rating of 20 percent or less through 2009.

It didn’t happen, however.
The VA did a single mailing of 17,2000 packets in May 2012 and then the
collaborative outreach effort with PDBR was suspended for 15
months. In June 2012, the PDBR was directed to focus its attention
on a special mental health diagnosis review ordered by then-Defense
Secretary Leon Panetta. The order came in the wake of allegations
that the MadiganArmyMedicalCenter at Fort Lewis, Wash., routinely had modified mental
health diagnoses of post-traumatic stress disorder to conditions that
resulted in lower disability ratings for soldiers.

That led to the services identifying
and mailing letters to every veteran separated from 9/11 through April
30, 2012, who completed a medical evaluation board and during disability
evaluation had their PTSD diagnosis or anxiety or depressive disorder
diagnosis changed or eliminated.

These special mailings resulted in the
services passing on to PDBR almost 940 applications, mostly from
soldiers, to review medical records and determine if applicants were
disadvantaged by decisions made during their original disability review
process.

Finally this fall, VA resumed mailings
to disabled veterans eligible for PDBR reviews, sending 20,000 packets
to VA addresses for qualified veterans separated through year 2005. More
mailings are planned every eight weeks, Davis said, until the effort is
complete, presumably sometime next year.

2014 COLA SET

Military and federal civilian retirees,
survivor benefit annuitants, disabled veterans and social security
recipients will get a 1.5 percent cost-of-living adjustment in
January.

Annual COLAs for federal benefits are
based on inflation, as tracked by the Bureau of Labor Statistics’
Consumer Price Index for Urban Wage Earners and Clerical Workers
(CPI-W). Changes in prices across a market basket of goods and
services from the third quarter of last year to the third quarter this
year determine the January COLA.

BLS senior economist Ken Stewart said
declines in gas prices from last year led to the modest inflation rate
reported. The COLA in 2013 was 1.7 percent.

Various debt-reduction studies
including the National Commission on Fiscal Responsibility and Reform,
also known as the Simpson-Bowles commission, have proposed moving from
CPI-W to a “chain-weighted” CPI for adjusting federal
entitlement and retirement programs. Proponents say it would save
an estimated $200 billion over the next 10 years.

Typically use of a chain CPI dampens
reported inflation by about .2 of percent a year. This year
produced an anomaly. If the chain CPI had been used instead of
CPI-W, with no other change in the formula for setting COLAs, federal
benefits still would be adjusted in January by 1.5 percent. – Tom
Philpott